Cardiac Specializations, Aging, CHF, Congenital Heart Dz, Ischemic Heart Dz Flashcards Preview

Cardiovascular Exam I > Cardiac Specializations, Aging, CHF, Congenital Heart Dz, Ischemic Heart Dz > Flashcards

Flashcards in Cardiac Specializations, Aging, CHF, Congenital Heart Dz, Ischemic Heart Dz Deck (78)
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1

Atrial myocytes have storage granules that contain ANP which promotes arterial vasodilation and stimulates natriuresis and diuresis, which is beneficial in the setting of ___ and ____

HTN; CHF

2

Due to their thin structure, heart valves derive most of their nourishment via _____; normal leaflets and cusps’ vessels are limited to the ____ portions

Diffusion; proximal

3

3 general types of damage that occur in valves

Collagen —> mitral prolapse

Nodular calcification —> calcific aortic stenosis

Fibrotic thickening —> rheumatic heart dz

4

During ventricular diastole, closure of the ____ valve leads to _____

Aortic; blood flow to myocardium

5

Describe cardiac stem cells

Bone marrow derived precursors and stem cells are present in the myocardium but only replace about 1% each year — thus no significant recovery in zone of necrosis

6

Effects of aging on myocardium and chambers of the heart

Increased LV chamber size, increased left atrial cavity size, sigmoid shaped ventricular sepum

Increased epicardial fat

Myocardium changes include lipofuscin, basophilic degeneration, and possible amyloid deposition

7

Effect of aging on heart valves

Aortic and mitral valves undergo annular calcification

Fibrous thickening

Mitral leaflets buckle towards left atrium —> increased left atrium size

Lambl excrescences = small filiform processes that form on closure lines of aortic and mitral valves, probably resulting from organization of small thrombi

8

Vascular changes that occur with aging

Coronary atherosclerosis

Stiffening and dilation of the aorta, elastic fragmentation and collagen accumulation

9

____ occurs when the heart is unable to pump blood at a rate to meet peripheral demand, OR can only do so with increased filling pressure

May result from loss of myocardial contractile function (systolic dysfunction) or loss of ability to fill the ventricles during diastole (diastolic dysfunction)

CHF

10

Cardiac myocytes become hypertrophic in the setting of sustained pressure or volume overload (such as in ____ or _____), or in the setting of sustained ____ signals (such as beta-adrenergic stim)

Systemic HTN; aortic stenosis

Trophic

11

In the setting of ______ overload hypertrophy, myocytes become thicker and the LV increases in thickness concentrically

In the setting of _____ overload hypertrophy, myocytes elongate and ventricular dilation is seen

Pressure

Volume

12

Hypertrophy of myocytes isn’t accompanied by a matching increase in blood supply despite increased energy demand — thus what is a major complication of cardiac hypertrophy?

Ischemia-related decompensation

13

Left sided heart failure can be systolic or diastolic; it is most commonly a result of what conditions?

Myocardial ischemia

HTN

Left-sided valve dz

Primary myocardial dz

14

What are the clinical effects of left sided heart failure? What causes them?

Clinical effects include paroxysmal nocturnal dyspnea, elevated pulmonary capillary wedge pressure, pulmonary congestion (cough, crackles, wheezes, blood-tinged sputum, tachypnea), restlessness, confusion, orthopnea, tachycardia, exertional dyspnea, fatigue, cyanosis

These occur d/t decreased tissue perfusion and congestion in pulmonary circ

15

Left-sided heart failure is characterized by left ventricular hypertrophy. Left ventricular dysfunction leads to left atrial dilation, resulting in what potential complications?

Atrial fibrillation, stasis, thrombus

16

The decreased ejection fraction associated with left sided heart failure may result in what complications concerning the kidneys?

Decreased EF —> decreased glomerular perfusion —> renin release —> increased volume

Prerenal azotemia

17

Histologic finding with left-sided heart failure

Heart failure cells = hemosiderin-laden macrophages

18

Advanced CHF may lead to decreased cerebral perfusion —> ____ ____

Hypoxic encephalopathy

19

Most common cause of right sided heart failure

Left sided heart failure

20

Isolated right sided heart failure may result from what conditions?

Anything that causes pulmonary HTN — parenchymal lung dz, primary pulmonary HTN, or pulmonary vasoconstriction

21

Clinical features of right-sided heart failure

In primary right sided failure, pulmonary congestion is minimal

The venous system is markedly congested, leading to:
Liver congestion (nutmeg liver)

Splenic congestion (splenomegaly)

Effusions involving peritoneal, pleural, and pericardial spaces

Edema, especially in dependent areas (e.g., ankles)

Renal congestion

Other Symptoms: fatigue, distended jugular vv, anorexia and complaints of GI distress, weight gain

22

Sporadic genetic abnormalities are the major known causes of congenital heart disease. What are the major examples?

Turner syndrome, trisomies 13, 18, and 21

The single MOST COMMON genetic cause of congenital heart disease is TRISOMY 21 — about 40% of pts with Down syndrome have at least one heart defect

23

Describe heart defects associated with trisomy 21

Usually derived from second heart field (arterioventricular septae) — most commonly defects of the endocardial cushion, including ostium primum, ASDs, AV valve malformations, and VSDs

24

What congenital heart diseases are associated with the Notch pathway?

Bicuspid aortic valve (NOTCH1)

Tetralogy of Fallot (JAG1 and NOTCH2)

25

______ mutations are associated with Marfan syndrome which is associated with ____ defects and aortic aneurysms

Fibrillin; valvular

26

Most common type of congenital cardiac malformation

Ventricular septal defect (VSD)

27

Genes associated with the nonsyndromic congenital heart defects

ASD or conduction defects (NKX2.5)

ASD or VSD (GATA4)

Tetralogy of fallot (ZFPM2 or NKX2.5)

Note that tetralogy of fallot when associated wtih alagille syndrome is associated with JAG1 or NOTCH2

28

What type of shunt is considered the most common congenital heart dz?

Left-to-right shunts — including ASD, VSD, and PDA

29

Of the common congenital left-to-right shunts, the _____ causes increased outflow volume from the RV and pulmonary system, while the ____ and _____ both cause increased pulmonary blood flow and pressure

ASD; VSD, PDA

30

T/F: Atrial septal defects tend to be rapidly fatal

False — ASDs are usually asymptomatic until adulthood